Session 2: Ageing and Falls in Older Adults

Question 1

What are the common changes associated with ageing across the key body systems and how these changes can impact pharmacokinetics and safe prescribing

Answer 1

resp system - lung and chest wall compliance decreases, TLC, FVC, FEV1 all reduced = all due to reduction in elastic support of airways so alveoli collapse and around oropharynx can lead to collapse of upper airway - partial or complete obstruction during sleep. Conditions such as atelectasis, PE and pneumonia are common post op
skin - thin skin and fragile subcutaneous blood vessels that bruise easily
CVS - large and medium sized arteries becomes less elastic and compliant so raised systemic vascular resistance and hypertension - left ventricular strain and hypertrophy, cardiac conducting cells decreases - heart block, ectopic beats, arrythmias and atrial fibrillation more common. and since atrial contractions is responsible for 10% of ED filling . overall, less cardiac output = circulation time for drugs increases and IV anaesthesia is achieved more slowly and with reduced does of agent
renal - GFR decreases due to progressive loss of renal cortical glomeruli also due to reduced renal perfusion, diabetes more common, use of nephrotoxic drugs such as NSAIDS and ACEi, obstructive nephropathy and dehydration is common
CNS - cerebrovascular disease common due to atherosclerosis and hypertension
endocrine - BMR falls by 1% per year after 30 and reduced muscle mass- impaired thermoregulatory control

Question 2

What are the common types of dementia and which brain regions are affected/

Answer 2

LEWY BODY- Dementia with Lewy bodies is caused by clumps of protein forming inside brain cells. These abnormal deposits are called Lewy bodies.
VASCULAR - Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells. This can happen as a result of:
narrowing and blockage of the small blood vessels inside the brain
a single stroke, where the blood supply to part of the brain is suddenly cut off
lots of “mini strokes” (also called transient ischaemic attacks, or TIAs) that cause tiny but widespread damage to the brain
ALZHEIMERS - At first, Alzheimer’s disease typically destroys neurons and their connections in parts of the brain involved in memory, including the entorhinal cortex and hippocampus. It later affects areas in the cerebral cortex responsible for language, reasoning, and social behavior. Eventually, many other areas of the brain are damaged.
FRONTOTEMPORAL - frontal and temporal lobe

Question 3

What functions (except memory loss) can be affected in patients with dementia and how this can impact their functioning?

Answer 3

may interpret things that happen differently
unanticipated periods of lucidity and periods of confusion
not recognise people or places they know well
may become frustrated with themselves or those who struggle to understand them
may not be able to communicate their anxieties, fears or frustrations
live with unpredictability - passage of time

Question 4

What is important in caring for older people?

Answer 4

patient centred compassionate care

Question 5

What is a major health problem all older people face and how can this be measured?

Answer 5

malnutrition - MUST nutrition tool

1. BMI
2. Weight loss
3. acute disease which can affect risk of malnutrition
4. overall risk (0=low, 1 = medium, 2 or more = high)

Question 6

What are the common causes of falls in older people?

Answer 6

syncope - transient loss of consciousness due to reduced cerebral blood flow
neurocardiogenic, cardiac arrythmia, structural cardio -pulmonary
non syncope - with or without loss of consciousness, not due to cerebral hypoperfusion
fall, psycogenic, TIA/stroke - no loss
epilepsy, metabolic, intoxications - partial or complete loss

Question 7

What are the risk factors for falls in older people?

Answer 7

joint problems
live alone
no mobility help
malnutrition/dehydration

Question 8

What is the mechanism that controls upright posture and balance with reference to the baroreceptor reflex?

Answer 8

decreases arterial pressure - decreased baroreceptor firing, increased sympathetic activity and decreased vagal, increased cardiac output and stroke volume - negative feedback - increasing arterial pressure

Question 9

What medications can cause falls?

Answer 9

Doctors prescribe anti-hypertensive medications to keep blood pressure under control and decrease the risk of stroke and heart failure. However, these drugs can cause blood pressure to get too low when you stand up from a lying or sitting position (orthostatic hypotension). This happens commonly in older folks. The result is lightheadedness and feeling faint, which can easily lead to a fall.

Medications that suppress the central nervous system are among those most likely to contribute to falling, as they reduce alertness and cause slower reactions and movements. These include:

Anti-anxiety drugs, such as diazepam
Diphenhydramine, an older antihistamine. Because it causes drowsiness, it is the most popular ingredient in over-the-counter sleep aids like Nyquil, Sominex, and Unisom
Prescription medications to treat overactive bladder, such as oxybutynin
Tricyclic antidepressants.
Prescription sleep drugs
Narcotics (opioids), such as codeine